Two Use Cases for Improving Outcomes with ADT Notifications: Part III

May 1, 2021, marked an important deadline for hospitals to comply with a requirement to send electronic admission, discharge, and transfer (ADT) event notifications to all providers primarily responsible for a patient's care as a condition of participation for Medicare and Medicaid. Given hospital reliance on these programs for revenue, the ADT requirement carries significant weight for a hospital found to be in non-compliance by an accreditation agency or state survey.

But there is much more at play for hospitals than simply complying with this new requirement. The efficient and secure exchange of health information is vital to improving care coordination, outcomes, and costs. In final installment of a three-part series, we explore real-world use cases for deploying electronic ADT notifications and its benefits for providers and patients.

Large and small organizations have struggled with the ability to do automated real-time event notifications. Here are two examples of organizations that realized the importance of ADT event notifications, and they have wasted little time implementing the technology and workflows necessary that make data-driven patient-centered care a reality.

UPMC and Winchester Hospital Independent Physicians Association are well-positioned for success, both motivated by providers to make ADT-related data exchange a central component of their care delivery approaches. 

Use Case 1: UPMC

The University of Pittsburgh Medical Center (UPMC) is a $21-billion-dollar global health system comprising 40 hospitals, 700 clinical locations, and a 3.9-million-member health plan.

Being able to keep the health system connected internally is itself a significant undertaking, on top of connecting with other providers in the region.

"Strategically, some of the biggest challenges for us from an interoperability perspective is to enable seamless data exchanges within UPMC, within all our hospitals, clinics, post-acute care providers, and also in the region with other health systems and referring providers," explained Kristian Feterik, MD, a hospitalist and clinical informaticist who serves as UPMC's Medical Director of Interoperability.

Implementing a standalone ADT-based notification solution has been essential to the organization's overall goal of keeping all the providers that are responsible for a patient's care in the loop.

"Especially with our more complex patients who have multiple medical problems, it is vital that everyone is kept on the same page, and if there are any changes to the treatment plan, that they are easily communicated," said Feterik.

Early on, UPMC recognized clear challenges to implementing an ADT solution based on the number of EHR systems used by providers in the health system and the relative capabilities of these systems to support ADT messaging. Because incorporating ADT event notifications into provider workflows was paramount, relying on EHR companies was not an option.

"At its core, the technology itself is quite simple, but if you look at the electronic health record vendor landscape, their implementation of Direct Secure Messaging and adoption across the country has been somewhat challenging and running into a few bumps in the road," Feterik observed.

What's more, providers themselves were unfamiliar with the technology itself, including not knowing their Direct email addresses.

At UPMC, Feterik and his team ensured the success of its ADT approach by aligning the solution with organizational and clinical goals. A primary goal was ensuring that hospital providers could effectively coordinate with post-acute care management and care teams to maintain continuity of care. Soon the organization discovered the importance of ADT notifications as a mechanism for helping patients with UPMC specialists but without primary care physicians benefit from an integrated care team and high levels of care coordination.

Given that home care visits amount to 750,000 at UPMC, enabling close loop referrals and communication motivated the organization to connect referral providers, community provider services team, and primary care physicians to all be able to receive notifications.

Thanks to having one standalone ADT solution, Feterik noted that it gives UPMC a strategic benefit of being able "to send the same ADT notification regardless of where the patient actually lands in our system."

While the health system is confident in its work to meet the compliance requirement for ADT event notifications, plenty of work remains. Much of that work revolves around the needs of individual patients given that 60–70 percent lack a properly identified primary care physician and many patients moving to post-acute care settings will rely on a multitude of providers, each needing to be alerted to ensure patients receive appropriate and timely care as a result of effective care coordination.

"We are very excited about our capabilities and being able to send out these notifications," Feterik emphasized.

Use Case 2: Winchester Hospital Independent Physicians

Independent physicians affiliated with the Massachusetts health system were experiencing a frequent problem — they weren't notified when patients were being admitted or discharged from the hospital.

"Patients were showing up for primary care appointments, and the physicians had no idea that they had been in the hospital or the ER. Physicians asked us what we could do to solve that problem," said Bill Mills, Director of Health Information Exchange for Highland Management. That latter is a group tasked with being the data connector between the Winchester Hospital Independent Physicians Association (IPA) and the local health system.

"That's when we went to ADT notifications so that the physician would get a notification at the time the patient was admitted into the hospital and discharged," he added.

Eventually, those admit, discharge, and transfer event notifications were extended to include urgent care centers in the area. When the local health system eventually moved to Epic, independent physicians wanted those same ADT notifications, particularly within their non-Epic EHR systems. Event notifications that are in the physician’s workflow are important for easy access to the information.

IPA physicians were using a score of different EHR systems. For Mills and his team, the obvious solution became the use of Direct Secure Messaging, but the challenge remained whether these numerous EHR systems were supporting Direct email addresses within their systems.

To address this complex situation, Highland Management sought a technology partner not only capable of supporting Direct-based ADT alerts but also able to provide detailed reports about the ADTs themselves: the physicians receiving them, the type of ADT messages they were receiving, and the date of the event.

Choosing a standalone service to manage the project met with resistance from hospitals preferring to use their own proprietary solutions or the Epic EHR. But Highland Management refused to budge because it did not want to lose the accountability of these reports, and it has paid off.

"We've had many alternatives, and when you look at them, they don't quite make the bar. They get up there, but they don't quite make that extra bar with what you need," noted Mills.

The group's ADT solution assists in providing Direct addresses and managing a reliable, up-to-date directory of provider Direct addresses to ensure the efficient routing of ADT messages. For independent physicians using EHRs that natively support ADT notifications, the alerts are available within that system. For those physicians with EHRs yet to play ball, access to an online portal gives doctors the ability to view information vital to effective follow-up to close care gaps and reduce readmissions.

According to Mills, those practices waiting on their EHR companies to incorporate ADT notifications into their systems "are going to wait a long time." Having a strategic ADT partner provides both high levels of functionality and accountability.

The end result is very little concern among the Winchester Hospital Independent Physicians Association and Highland Management for meeting the compliance mandate. Their main concern remains ensuring that this information is shared securely with the right providers and leads to a more engaged and responsive provider community.

Complying with the CMS mandate for ADT event notifications is just scratching the surface of what this technology can actually do. Hopes are that these notifications can become a means of delivering information payloads that can give insight to providers leading to timely action and better outcomes. Clinicians at the point of care seek access to the most timely and appropriate information in order to provide highly effective individualized care to each patient. By deploying a robust electronic ADT event notification solution, hospitals will not only comply with the federal mandate but also pave the way to more seamless care coordination.

*Editor's note: Portions of this article have been updated to conform with the CMS compliance date.

See the other articles in this series on the ADT Notification Requirement:

• How Hospitals Comply with the ADT CoP Requirement: Part I
• What It Means to Go Beyond ADT Notification Requirement: Part II

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If you would like to learn more about these use cases, check out this interactive panel webcast, "How Two Large Health Systems Gained Success with ADT eNotifications"

About Consensus Signal

The real-time ADT notification solution used by these health systems is powered by Secure Exchange Solutions (SES), which provides secure, cloud-based clinical data exchange solutions that accelerate interoperability between healthcare communities. Consensus Signal has joined in partnership with SES to offer real-time ADT notifications to hospitals and health systems. To learn more, go to www.consensus.com/signal/